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donderdag 18 januari 2018

The Lancet: [Articles] Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virologi...

[Articles] Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virological suppression in adults with HIV-1: phase 3, randomised, non-inferiority SWORD-1 and SWORD-2 studies
Dolutegravir-rilpivirine was non-inferior to CAR over 48 weeks in participants with HIV suppression and showed a safety profile consistent with its components. Results support the use of this two-drug regimen to maintain HIV suppression.
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[Comment] Combination ART: are two drugs as good as three?
The first 10 years of the development of antiretroviral therapy (ART) were characterised by a series of studies that led to the conclusion that triple therapy was the minimum required to induce and maintain full suppression of HIV replication. Early reports of using monotherapy with a nucleoside reverse transcriptase inhibitor (NRTI) had shown only transient decreases in p24 antigen and arrest of HIV disease progression.1 Studies of dual NRTI therapy showed more robust responses, but again these responses were temporary and unsustained in most individuals in the studies.
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[Health Policy] Progress in clinical research in surgery and IDEAL
The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. This evidence deficit can adversely affect research funding and reimbursement decisions, lead to slow adoption of innovations, and permit widespread adoption of procedures that offer no benefit, or cause harm. Improvement in the quality of surgical evidence would therefore be valuable.
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[Articles] Single dose moxidectin versus ivermectin for Onchocerca volvulus infection in Ghana, Liberia, and the Democratic Republic of the Congo: a randomised, controlled, double-blind phase 3 trial
Skin microfilarial loads (ie, parasite transmission reservoir) are lower after moxidectin treatment than after ivermectin treatment. Moxidectin would therefore be expected to reduce parasite transmission between treatment rounds more than ivermectin could, thus accelerating progress towards elimination.
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[Comment] A new powerful drug to combat river blindness
Onchocerciasis, which is a disease caused by the filarial worm Onchocerca volvulus, is transmitted from individual to individual by Simulium black flies that breed in fast flowing rivers. The millions of larvae (microfilariae) released by the adult parasites invade skin and eyes where they can cause severe manifestations, including blindness. International control programmes for onchocerciasis have been implemented since the 1970s. Insecticide spraying to eliminate the vector was supplemented by, and ultimately replaced from the 1990s by, mass administration of ivermectin, a drug which kills microfilariae and prevents their release by the adult worms for several months.
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woensdag 17 januari 2018

RCGP: RCGP Wales: Parliamentary Review of Health and Social Care addresses challenges head on

RCGP Wales: Parliamentary Review of Health and Social Care addresses challenges head on

The Parliamentary Review of Health and Social Care is an independent review into the future of health and social care in Wales by an international panel of experts.

Dr Rebecca Payne, Chair of RCGP Wales, said:

"This is a constructive report that addresses the deep-rooted challenges that are currently holding back progress in the Welsh NHS.

"It acknowledges the significant workforce challenges that many NHS professions are facing, which we can see clearly in general practice and why we've asked for an increase to 200 GP training places a year. It also recognises that engaging and supporting the workforce is vital if we are to see improvement, noting the difficulty in making change on the ground given current management and leadership structures. The identification of a lack of primary care representation on health board executives is also welcome, as well as the call for an independent NHS Wales executive.

"The report restates the view that Wales needs to reorient the balance between community care and acute care, strengthening primary care. A thriving primary care sector, with general practice at its core, will deliver better patient outcomes across Wales.

"Of course, the real test will be whether this report leads to an improvement in patient care, and we call on the Welsh Government to implement the recommendations of this report at pace."

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RCGP welcomes appointment of minister with responsibility for tackling loneliness

"Loneliness and social isolation can be as bad for our patients' health as a chronic long-term condition. This was my message when I addressed delegates at the College's Annual Conference last year – and we welcome these steps that the government is taking to help tackle this very real issue.

"GPs see many elderly patients who have multiple, long-term health problems like diabetes and hypertension, but in some cases the underlying reason behind visiting their GP isn't medical – they're lonely.

"And loneliness is not exclusive to the elderly, it is something that can have a serious negative impact on the health and wellbeing of anyone; particularly carers, young disabled adults, and those who have lost loved ones.

"We hope the creation of a ministerial lead for loneliness and social isolation will help provide solutions for the millions of lonely and socially isolated patients we see in general practice – and those we don't – and bring about the change we need to see for people of all ages, backgrounds, and communities across the UK."

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Patient testing needs to be based in evidence, says College

Responding to the All-Party Parliamentary Group's report on blood cancer care, Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said:

"GPs understand that timely diagnosis of cancer leads to better outcomes for patients – and the latest data shows that over 75% of all cancer cases are referred by GPs after just one or two consultations.

"This is really good news, particularly considering, as this report recognises with blood cancer, how difficult identifying symptoms can be in primary care given that a GP, on average, will see less than one case of blood cancer every year.

"The term blood cancer is used to cover a range of conditions including leukaemias, lymphomas and myeloma; leukaemia is usually picked up through one of the tests that GPs order very frequently - a full blood count. But each type of blood cancer can present in a varied way, and GPs will base their decisions around what diagnostic testing is most appropriate on the symptoms being displayed by, and the unique circumstances potentially affecting, the patient in front of us.

"Any decision to pursue opportunistic testing must not be undertaken lightly as GPs need a good scientific evidence base before they order any investigations.

"What is certainly needed for GPs to continue doing a good job at identifying any cancers in a timely way, is better access to diagnostic tools in the community, so that we can appropriately investigate and refer patients as well as we can.

"The RCGP is working with Cancer Research UK, and others, to develop resources to support GPs in the timely identification and diagnosis of cancer."

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RCN canvases views of members on organ donation rules

RCN canvases views of members on organ donation rules
The Royal College of Nursing has announced it is reviewing its official position on organ donation in response planned changes to the law in parts of the UK that would mark a major change of stance.
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Breastfeeding for six months 'protects' against type 2 diabetes
Breastfeeding for six months or more nearly halves the risk of women developing type 2 diabetes, a new long-term US study has found.
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London trust to roll out Buurtzorg community nursing model
A London trust is looking to roll out a new nurse-led model of community care, after patients and staff said quality of care improved during its test phase.
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Tool launched to reduce 'variability' in dementia training quality
Tailoring and face-to-face delivery are among the keys to providing effective training on dementia, according to researchers behind a new tool that is being adopted nationally to assess programmes.
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Replica bus stop installed by hospital to help dementia patients
A special bus stop is providing dementia patients with a "quiet and safe place" to help prevent them becoming unsettled or anxious, according to Northern Lincolnshire and Goole NHS Foundation Trust.
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Improving nursing image 'crucial' to attracting and retaining staff
How the nursing and midwifery professions are perceived needs to be improved in schools, among the public and the media, and also within the current workforce itself, according to a nurse leader.
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NHS Employers: Supporting staff retention with reward

Supporting staff retention with reward
Learn how Sandwell and West Birmingham Hospitals NHS Trust used reward to help improve staff retention
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flu fighter conference and awards to take place in April
Book your place at the flu fighter conference and find out how to enter the flu fighter awards 2018.
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Change of publication date for gender equality monitoring
The deadline for publishing gender equality monitoring information in NHS organisations has changed.
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BBC Health: Why are so many nurses quitting the NHS?

Why are so many nurses quitting the NHS?
Why are so many nurses quitting the NHS?
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When you can (and can't) eat carbs for dinner
Is it true that you shouldn't eat carbohydrates in the evening?
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Changing profession
From nurses who operate on their patients to those who run general practices, nursing is changing.
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Health service 'haemorrhaging' nurses, figures reveal
More than one in 10 leave the NHS in England every year, enough to staff more than 20 hospitals.
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Minister for loneliness appointed to continue Jo Cox's work
The government creates a new ministerial role, which continues the work of the late MP Jo Cox.
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Gov UK: Guidance: The wellbeing of 15-year-olds: analysis of the What About YOUth? survey

Guidance: The wellbeing of 15-year-olds: analysis of the What About YOUth? survey
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Guidance: Sexually transmitted infections: Yorkshire and Humber data
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Press release: World leading cancer dataset shows improvements in diagnosis
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